Friday, April 1, 2022

Severe Substance Use Disorder Symptoms in Adolescence Found to Persist Into Adulthood

More than half of adolescents who have severe substance use disorder (SUD) symptoms at age 18 will continue to have SUD symptoms decades into their adulthood, a study in JAMA Network Open has found. People who had severe SUD symptoms when they were 18 years old were also more likely to report prescription drug use and misuse in adulthood.

“These findings suggest that most adolescents with severe SUD symptoms do not transition out of symptomatic substance use, and the long-term sequelae for adolescents with more severe SUD symptoms are more deleterious than those for adolescents with no or low severity,” wrote Sean Esteban McCabe, Ph.D., of the University of Michigan and colleagues.

The researchers analyzed data from 5,317 people (51.2% were female, and 77.9% were White) in the Monitoring the Future study who were followed from age 18 years (1976-1986) to age 50 years (2008-2018). The participants took baseline surveys in classrooms and follow-up surveys by mail. Symptoms of SUD were measured with several questions based on DSM criteria, and DSM-IV and DSM-5 were used over the course of the study. Fifteen items on the survey assessed whether participants ever encountered problems related to substance use, such as failure to fulfill major role obligations, continued substance use despite persistent or recurrent interpersonal or social problems, and continued substance use when physically or psychologically hazardous.

At age 18 years, 20.1% of participants reported two or three SUD symptoms, 12.1% reported four or five SUD symptoms, and 11.5% reported six or more SUD symptoms. Among those with the most severe SUD symptoms (six or more symptoms), 61.6% had two or more SUD symptoms in adulthood. Those who had at least four SUD symptoms as adolescents had roughly 1.55 times the odds of prescription drug use and misuse as adults compared with those with fewer or no SUD symptoms. Furthermore, 52.2% of adults who reported using prescribed opioids, sedatives, or tranquilizers in the past year had multiple SUD symptoms when they were 18 years old.

“Prescribers should be aware that many adults prescribed opioids, sedatives, or tranquilizers had multiple SUD symptoms during adolescence and require careful assessment and monitoring,” McCabe and colleagues wrote. “The present findings suggest that clinical assessment should screen for SUD symptom severity during adolescence and that continued education is warranted.”

In an accompanying editorial, National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D., and Eric M. Wargo, Ph.D., also of NIDA, reflected on the potential value of screening that captures the intensity of substance use by adolescents as well as the need for interventions targeting substance use in this population.

“Drug use and related behavioral problems are preventable when communities, schools, and health care systems are willing to invest in evidence-based prevention and therapeutic interventions appropriate to the youth’s risks,” Volkow and Wargo wrote. “For this to occur, health care systems must incorporate screening for drug use and SUD, including SUD severity, in office visits, and ensure that screening, prevention, and quality treatment are reimbursable by insurance.”

For related information, see the Psychiatric News article “Youth Addictive Disorders: A Call for a Developmentally Informed Approach.”

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